Most of the patients undergoing the 45 million surgical procedures in the US each year will experience perioperative hypothermia unless effective safe practices are used. Mild hypothermia triples the risk of surgical site infection, quadruples the risk of morbid cardiac events, and increases blood loss. Perioperative hypothermia increases the duration of action of anesthesia and neuromuscular blocking agents and extends postanesthesia recovery by an average of 90 minutes. This unsafe condition increases the cost of care of a surgical patient by an average of $2500 to $7000 per patient. The objective in this application is to evaluate the effect of the Prevention of Perioperative Hypothermia (PPH) Safety Toolkit on adherence to safe practices for prevention of perioperative hypothermia (preoperative forced air warming, intraoperative forced air warming, and warming of intravenous fluids) and selected outcomes (e.g. rates of hypothermia, cost). Phase I included: conducting a risk assessment, conducting a Healthcare Failure Mode and Effect Analysis (HFMEA), identifying barriers and facilitators to adherence to safe practices, and developing a prototype of the PPH Safety Toolkit, including educational programs, an electronic checklist, and tools for evaluating processes and outcomes. Based upon preliminary work completed in Phase I, we are implementing and evaluating the toolkit outlined in this proposal as Phase II of our ongoing work. Our Specific Aims are to: Aim 1: Evaluate the effect of use of the PPH Safety Toolkit on staff knowledge and adherence to safe practices for prevention of perioperative hypothermia in adult patients undergoing elective surgery; Aim 2: Evaluate the effects of use of the PPH Safety Toolkit on selected patient outcomes of perioperative hypothermia and duration of postanesthesia recovery, in adult patients undergoing elective surgery; Aim 3: Evaluate the effect of use of the PPH Safety Toolkit on selected facility-level variables of cost of patient care, and staff satisfaction with processes. Upon completion of this project, we will refine the PPH Safety Toolkit, producing a final product for public access through the Association of periOperative Registered Nurses (AORN) website. The toolkit will be adaptable for use in other hospitals and ambulatory surgery centers. Through dissemination, it has the potential to improve patient care nationwide. The knowledge gained through this study can be generalized to implementation of other safe practices, improving quality, safety, efficiency, and effectiveness of healthcare.